The Current State of Prerequisite Coursework in Health Professions Education: Function, Assumptions, and Best Practices for a Path Forward.

Prerequisite courses have been a staple in admissions requirements for health programs for more than a century. Prerequisites serve various roles including achieving accreditation standards, determining academic preparation, predicting academic success, and informing admissions decisions. While the theories purported to support prerequisite courses have largely remained static, the challenges for educators and applicants have evolved. In addition to training future healthcare providers, contemporary educators are focused on attracting and training a diverse workforce as well as attaining enrollment targets to ensure financial stability. We propose 4 assumptions that pit common prerequisite practices against these contemporary challenges including limitations caused by the cost of prerequisites, disproportionate burden on underrepresented minorities, extraordinarily complex and variable policies, and a disconnect between grades and knowledge retention. Continuing to operate under these assumptions creates unnecessary barriers for potential students. We offer model practices for approaching prerequisites with more flexibility. These practices involve refining expectations for learning, normalizing alternatives to coursework, conducting prospective research, analyzing relevant data, and exploring more personalized pathways and holistic practices. As higher education changes and the demand for healthcare providers increases, innovation to the admissions process is needed to identify those who can complete programs and become competent healthcare providers.